NO PERMIT NUMBER (3)a
Street a
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO
Fila No.
nits ry No./
Dote 196
plication is hereby mad: for a permit to
st ry, Type t -X 10
to be occupied onl s
in accordance with Plot Plan, Plans anaw Specification filed herewith.
Est' red ted Value of Improvements $ - t/ O
�%�
FEE$ / . UU Plan Check $
Owner Address
oC n -FF'- `/p AAAA , Address
PhoneLicense
ApprovedVAJf 1 rnnn I nrn1e.1i1-
APPLICATION FOR ELECTRICAL PERMIT
Date 196 FEE$
Contr
Phone
Address
State License
Approved
APPLICATION FOR PLUMBING & GAS PERMIT
Dote 196
Contr.
Phone
Date
Contr
GAS FEE $ —
PLUMBING FEE $
Address
State License
Approved
APPLICATION FOR APPLIANCE PERMIT
196 FEE$
Address
Phone State License
Approved _
Applicants agree, not to violate any of the
Workman's Compensation Laws of the
State of California
RECORD OF INSPECTION APPROVALS
I SIZE
BUILDING
FOUNDATION
SWITCHES
Inspector
Date
UNDERFLOOR
REGISTERS
H.P. CHARGE
Inspector
Date
FRAME
Inspector
Data
Inspector
Do to
LATH & PLASTER
MISC
Date
Inspector
Do to
FINAL-
INAL
MISC
Date
,/Iir ,
,/I
Date//-�/-�
CAL
Inspector
Inspector
Inspector
Inspector
Ins oector
SERVICE SIZE
UNDERGROUND
I SIZE
,OUTLETS
TYPE OF APPLIANCE
SWITCHES
Inspector
RECEPTACLES
FIXTURES
REGISTERS
H.P. CHARGE
Inspector
PERMIT FEE
TOTAL FEES
Inspector
CAL
Inspector
Inspector
Inspector
Inspector
Ins oector
SERVICE SIZE
UNDERGROUND
I SIZE
'IWWATER
TERIAL
TYPE OF APPLIANCE
Date
Inspector
ROUGH WIRING
FIXTURE FEE
REGISTERS
Date
Inspector
FINISH WIRING
Date
Inspector
Data
Inspector
FIXTURES
MISC
Date
Inspector
Motors
MAIN DRAIN
MISC
Date
Inspector
FINAL
Inspector
WATER SYSTEM FEE
Date Inspector
PLUMBING & GAS
MAIN DRAIN SIZE MATERIAL
ISTORM DRAIN SIZE MATERIAL
SYSTEM
I SIZE
'IWWATER
TERIAL
TYPE OF APPLIANCE
TOTAL FIXTURES
FEE
UNDERGROUND
FIXTURE FEE
REGISTERS
PARTIAL ROUGH
BLOWER FURNACES
Date
Inspector
MAIN DRAIN FEE
ROUGH COMPLETE
MISC
Date
Inspector
STORM DRAIN FEE
MAIN DRAIN
MISC
Date
Inspector
WATER SYSTEM FEE
PERMIT FEE
GAS PIPING
FLOOR FURNACE
Data
Inspector
GAS PIPING FEE
FINAL
Date
Inspector
PERMIT FEE
MISC
Date
Inspector
TOTAL FEE �
MISC
Vote Inspector
APPLIANCE
TYPE OF APPLIANCE
UNITS
FEE
TYPE OF APPLIANCE
UNITS
FEE
CIRCULATING HEATERS
REGISTERS
BLOWER FURNACES
COMBUSTION VENT
SUSPENDED UNIT
MISC
GAS RANGE
MISC
GAS DRYER
PERMIT FEE
FLOOR FURNACE
TOTAL FEE
INSPECTED
Date Inspector